A nurse is working with a patient diagnosed with bipolar disorder. The patient is in the manic phase and is exhibiting impulsive behaviors. Which of the following behaviors should the nurse be most concerned about?

Correct Answer: B

Rationale: In this scenario, the correct answer is option B) Spending large amounts of money impulsively. The nurse should be most concerned about this behavior because it can have serious consequences for the patient's financial well-being and stability. Impulsive spending during a manic episode is a common symptom of bipolar disorder and can lead to financial ruin, debt, and other negative outcomes. Option A) Excessive talking and rapid speech, while also common in manic episodes, may not pose an immediate risk to the patient or others. It is more of a symptom of the manic phase rather than a behavior with potentially harmful consequences. Option C) Engaging in social activities and making new friends can be positive aspects of a patient's life and may not necessarily be harmful during a manic episode. However, it is important for the nurse to monitor these interactions to ensure they are not exacerbating the manic symptoms or leading to risky behaviors. Option D) Participating in group therapy sessions is actually a positive behavior that can be beneficial for the patient's mental health. While it is important for the nurse to assess the patient's behavior in group therapy to ensure they are not disrupting the session or exhibiting harmful behaviors, it is not typically a cause for immediate concern in the context of a manic episode. Educationally, this question highlights the importance of understanding the manifestations of bipolar disorder, particularly during manic episodes, and the need for nurses to prioritize interventions based on the level of risk posed by specific behaviors. It also underscores the significance of vigilant monitoring and assessment in managing patients with psychiatric disorders.

Correct Answer: B

Rationale: The most appropriate response is option B: "Let's talk about why you don't feel like eating and how we can help you." This response is person-centered and therapeutic, focusing on exploring the patient's feelings and experiences around eating rather than imposing judgment or directives. Option A is incorrect because it may come across as confrontational and could reinforce feelings of guilt or shame in the patient. Option C, while emphasizing the importance of eating, does not address the underlying reasons for the patient's lack of appetite. Option D focuses on the physical consequences of not eating but does not address the patient's emotional or psychological needs. In the context of caring for a patient with anorexia nervosa, it is crucial to approach them with empathy, understanding, and a non-judgmental attitude. Patients with eating disorders often have complex relationships with food, body image, and control. By exploring the reasons behind the patient's lack of appetite and collaborating on finding solutions, the nurse can build trust and facilitate a more effective therapeutic relationship to support the patient in their recovery journey.

Correct Answer: C

Rationale: By asking if the patient does not believe that progress has been made, the nurse is reflecting or paraphrasing by putting into words what the patient is hinting. By making communication more explicit, issues are easier to identify and resolve. The remaining options are nontherapeutic techniques. Telling the patient not to 'talk that way' is disapproving. Saying that everyone feels that way at times minimizes feelings. Telling the patient that good work will always result in success is falsely reassuring.

Correct Answer: A

Rationale: Giving advice fosters dependence on the nurse and interferes with a patient's right to make personal decisions. It robs the patient of the opportunity to weigh alternatives and develop problem-solving skills. Furthermore, it may contribute to a patient's feelings of personal inadequacy. Giving advice also keeps the nurse in control and feeling powerful.

Correct Answer: A

Rationale: In this scenario, the priority nursing intervention is option A) Ask the patient about their suicidal thoughts and plans. This is the correct choice because the patient's statement, "I don't feel anything anymore. Nothing matters," indicates a sense of hopelessness and emotional numbness, which are common in individuals with major depressive disorder and could be associated with suicidal ideation. By addressing suicidal ideation directly, the nurse can assess the patient's risk of harm to themselves and initiate appropriate interventions to ensure their safety. Suicidal ideation is a critical concern in individuals with major depressive disorder and requires immediate attention to prevent self-harm or suicide attempts. Options B, C, and D are incorrect in this context. Encouraging the patient to participate in activities or reassuring them that their feelings will improve overlook the seriousness of the patient's statement and do not address the potential risk of suicide. Providing support and allowing the patient to express their feelings are important aspects of care but should not take precedence over assessing and addressing suicidal ideation, which is the most urgent concern in this situation. From an educational perspective, this question highlights the essential role of nurses in assessing and managing suicidal ideation in patients with major depressive disorder. It emphasizes the importance of prioritizing safety and implementing appropriate interventions to address the immediate risk of harm. This scenario underscores the critical need for nurses to be vigilant in recognizing warning signs of suicide and taking proactive steps to ensure patient safety and well-being.